Glatte Patrick, Buchmann Sylvia J, Hijazi Mido Max, Illigens Ben Min-Woo, Siepmann Timo
Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
Department of Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
Front Neurol. 2019 Sep 10;10:970. doi: 10.3389/fneur.2019.00970. eCollection 2019.
The human skin is a highly specialized organ for receiving sensory information but also to preserve the body's homeostasis. These functions are mediated by cutaneous small nerve fibers which display a complex anatomical architecture and are commonly classified into cutaneous A-beta, A-delta and C-fibers based on their diameter, myelinization, and velocity of conduction of action potentials. Knowledge on structure and function of these nerve fibers is relevant as they are selectively targeted by various autonomic neuropathies such as diabetic neuropathy or Parkinson's disease. Functional integrity of autonomic skin nerve fibers can be assessed by quantitative analysis of cutaneous responses to local pharmacological induction of axon reflex responses which result in dilation of cutaneous vessels, sweating, or piloerection depending on the agent used to stimulate this neurogenic response. Sensory fibers can be assessed using quantitative sensory test. Complementing these functional assessments, immunohistochemical staining of superficial skin biopsies allow analysis of structural integrity of cutaneous nerve fibers, a technique which has gained attention due to its capacity of detecting pathogenic depositions of alpha-synuclein in patients with Parkinson's disease. Here, we reviewed the current literature on the anatomy and functional pathways of the cutaneous autonomic nervous system as well as diagnostic techniques to assess its functional and structural integrity.
人类皮肤是一个高度专业化的器官，不仅用于接收感觉信息，还用于维持身体的稳态。这些功能由皮肤小神经纤维介导，它们呈现出复杂的解剖结构，通常根据其直径、髓鞘化程度和动作电位传导速度分为皮肤A-β、A-δ和C纤维。了解这些神经纤维的结构和功能很重要，因为它们是各种自主神经病变（如糖尿病神经病变或帕金森病）的选择性靶点。自主皮肤神经纤维的功能完整性可以通过对局部药理学诱导轴突反射反应的皮肤反应进行定量分析来评估，根据用于刺激这种神经源性反应的药物不同，轴突反射反应会导致皮肤血管扩张、出汗或竖毛。感觉纤维可以使用定量感觉测试进行评估。作为这些功能评估的补充，浅表皮肤活检的免疫组织化学染色可以分析皮肤神经纤维的结构完整性，这项技术因其能够检测帕金森病患者α-突触核蛋白的致病性沉积而受到关注。在这里，我们回顾了关于皮肤自主神经系统的解剖学和功能途径以及评估其功能和结构完整性的诊断技术的当前文献。
